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Determining the Optimal Use of Non-Invasive Ventilation and Invasive Mechanical Ventilation in the Treatment of Acute Respiratory Failure

Abdullah Al-Murad

Background: Acute respiratory failure (ARF) is a life-threatening condition requiring mechanical ventilation to support gas exchange. Non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV) are two modes of mechanical ventilation commonly used in the treatment of ARF. The optimal use of NIV and IMV remains controversial, and understanding the best approach is crucial for optimizing patient outcomes.

Objectives: This review aims to determine the optimal use of NIV and IMV in the treatment of ARF by synthesizing the available evidence and highlighting areas where further research is needed.

Methods: A systematic review of the literature was conducted. Randomized controlled trials and observational studies that investigated the use of NIV and IMV in the treatment of ARF were included. The primary outcomes of interest were mortality, intubation rates, and length of hospital stay.

Results: NIV reduced the need for intubation and decreased mortality in patients with chronic obstructive pulmonary disease (COPD) and cardiogenic pulmonary edema. IMV improved mortality and increased ventilator-free days in patients with acute respiratory distress syndrome (ARDS). NIV was found to be the preferred mode of ventilation for hypoxemic respiratory failure, reducing the need for intubation and mortality. However, the optimal use of NIV and IMV in ARF requires careful consideration of patient characteristics. Limitations of the available evidence include a lack of consistency in study design and sample sizes.

Conclusions: NIV and IMV are both effective in the treatment of ARF, and the optimal use depends on the underlying etiology and patient characteristics. NIV should be considered as the first-line treatment for hypoxemic respiratory failure, while IMV may be preferred in patients with ARDS. However, additional research is needed to further define the optimal use of NIV and IMV in different patient populations. Clinicians should carefully evaluate patients and consider the risks and benefits of each mode of ventilation before making treatment decisions.